Molar Uprighting Simple Technique

8/13/2019 Molar Uprighting Simple Technique

1/4

73

Vol. 1 Issue 2 November 2009

Copyrights @ Indian Journal of Dental Sciences. All rights reserved.

MOLAR UPRIGHTING SIMPLE TECHNIQUE[M.U.S.T]

A SHORT TERM CLINICAL EVALUATION

* Harshal Kumar ** K. Vijayalakshmi

* Asst. Proff . - Dept of orthodontics, Himachal Dental College & Hospital, Sundernagar, H.P** Proff. & Head Rajah Muthiah Dental College & Hospital, Annamalainagar - T.N

ABSTRACT

Loss of first permanent molar is a frequent problem in adults. The sequel to this is tipping, drifting, or rotation of the adjacentteeth . This depends on the position, age & the number of teeth lost. This study was done to evaluate the treatment efficiencyof M.U.S.T with least armamentarium and time. Five patients, one male and four females were selected randomly, all were

having missing first permanent molar or second Premolar. The permanent molar adjacent to the space was having a mesialInclination with a fair periodontal condition. All were treated with M.U.S.T. for a period of two months and a careful appraisaland evaluation was done of the study cast, lateral cephalograms and intra oral radiographs. Materials used were two molartubes of 0.018x 0.025 with 0 o torque, super elastic 0.016x 0.022 Nickel titanium wire, Molar band 180 x 0.005 &Glass Ionomer Cement. The paired-t test was done after super imposition of the pre-post cephalograms and study models.95% change in crown angulations was noted but the root movement was non-significant.

Keywords : M.U.S.T, Mesial Inclination, Treatment Efficiency, Superimposition

INTRODUCTIONVanarsdall & Swartz 1 said that due to early

loss of permanent molars the adjacent teethtilts mesially , molar uprighting involves the

correction of these mesially tilted molars.M.U.S.T was originally done by Elie Capelluto& Isabelle Lauweryns 2 to upright mesially tiltedmolars without extrusion. In the study by Drescher& colleagues only the burstone uprighting springmade of TMA wire produced an intrusive forceduring the molar uprighting. However this springrequired delicate control since small differencesin the bending angles could change the forcedelivery considerably. Recently they introduceda new uprighting spring consisting of a titaniumwire connected to mesial & distal stainless steelwire which are fixed to attachments on thepremolar & second molar. While the spring wasshown to produce both an up righting moment &an intrusive force on the molars , it is still difficultto adjust in mouth . Melsen & colleagues pointedout the significant changes in a geometry V forcesystem delivered by a T loop or V bend that arecaused by displacing the loop to one side or theother. They suggested a two cantilever system foruprighting molars. Since both the forces produceuprighting moments, activation is controlled by

varying the relative moment to force ratios of thecantilevers. This method although provides bettercontrol of the moments, is difficult & complex inexecution.

Edward H. Angle 3 called the first molar thekey to occlusion. Graber.T.M 4 said that the earlyloss of first permanent molars leads to mesialmigration of the adjacent teeth that is the secondpermanent molar and the third permanent molarsare tipped mesially or rotated. These are in suchposition that is conducive neither to a long termhealth nor to simple restorative procedures. Inaddition the premolars may have drifted distallyand rotated, resulting in open contacts in poormarginal ridge relationships. The opposing teeth

may supra erupt into the edentulous space furthercomplicating the situation.

These mesially tipped or tilted molars cannotbe used as an anchor molar as the forces will leadto further tipping of the molars. As the teeth movesmesially the adjacent tissue becomes folded anddistorted forming a plaque harboring pseudopocket which may be virtually impossible to cleanthus leading to accumulation of bacterial plaquewhich damages the periodontium by stimulatingan immune response.


2/4

74



AIMS AND OBJECTIVESThis study was conducted to

1. Evaluate the efficiency and performance of

molar up righting simple technique M.U.S.Twithout extrusion.

2. Evaluate the model, and cephalometricchanges encountered during the molar uprighting.

MATERIALS AND METHODS1. Two molar tubes

Size-0.018 x 0.025

Torque - 0 degree torque

2. Active Component

Super elastic 0.016 x 0.022 nickel titaniumwire

3. Glass ionomer cement

Powder + liquid

4. Molar Band

Size-180 x 0.005

APPLIANCE DESIGN ANDBIOMECHANICS

One 0.018 x 0.025 molar tube is solderedcervically to the molar tube parallel to the occlusalplane .A shorter 0.018 x 0.025 tube is solderedhorizontally to the cervical area of the premolar.Both the tubes have a 0 0 torque. The activecomponent 0.016 x 0.022 super elastic nickeltitanium wire extends from the mesial of thepremolar tube to the distal of molar tube. Eachend of the wire is covered with glass ionomercement to avoid irritation and distortion. The areaanterior to the molar can be stabilized with lingualbar or lingual button connected with passive elasticchain or with anchorage to the fixed appliance.(Fig 1). pre treatment & post treatment intra oralperiapical radiographs were taken for all of thepatients . ( Fig 2 ) . pre treatment & post treatmentintraoral photographs were taken for all thepatients . ( Fig 3 ) & ( Fig 4 ) . pre treatment &post treatment cephalogram were superimposed .( Fig 5 )

Figure - 1

Figure - 3

Figure - 4

Figure - 5

Figure - 2


3/4

75



TABLE I: CEPHALOMETRIC LANDMARKS FORUPPER MOLARS

R Distance between distal root tip of molar andPTV line (Pre-treatment)

R1 Distance between distal root tip of molar andPTV line (Post-treatment)

C Distance between distal cusp of molar and PTVline (Pre-treatment)

C1 Distance between distal cusp of molar and PTVline (Post-treatment)

M Angle between a line passing through centre of molar bisecting the palatal plane (Pre-treatment)

TABLE II: CEPHALOMETRIC LANDMARKS FORLOWER MOLARS

R Distance between distal root tip of molar and

PTV line (Pre-treatment)R1 Distance between distal root tip of molar and

PTV line (Post-treatment)

C Distance between distal cusp of molar and PTVline (Pre-treatment)

C1 Distance between distal cusp of molar and PTVline (Post-treatment)

M Angle between a line bisecting the centre of molarand passing through the mandibular plane (Pre-treatment)

M 1 Angle between a line bisecting the centre of molar

and passing through the mandibular plane (Post-treatment)

NOTE: PTV line was drawn perpendicularto Frankfort plane.

STUDY MODELS

According to Hom and Turley5

th emesiodistal distance from the contact point of molar to contact point of the other teeth beyondthe spacing was measured with the help of verniercaliper. The distance between their cervicalregions was also measured. ( Fig 8 )

TABLE III: MEASUREMENT OBTAINED BY STUDYMODELS

Contact Cervical DistancePoint Distance

Case 1 Pre 3mm 4mmPost 5mm 5mm




Case 5 Pre 7mm 6mm

Post 6mm 7mm

TABLE IV: MEASUREMENT OBTAINED AFTERCEPHALOMETRIC SUPERIMPOSITION

M M1 C C1 R R1

Case 1 97 o 86 o 19mm 16mm 11mm 12mm

Case 2 145 o 122 o 7mm 3mm 10mm 8mm




Figure - 8Figure - 6

Figure - 7


4/4

76



resistance. The more activation is applied morethe distalization will occur. The movementdelivered by this couple will accentuate thesuprighting movement in sagittal plane.Advantages of M.U.S.T was patient comfort, therewas no occlusal interference, neither was any wiredeformation from mastication.

Intra oral activation was fast and treatmenttime was relatively short. Furthermore the integrityof the molar was preserved so that no occlusalrecontouring was needed after up righting.Findings in this study indicates that orthodonticmolar up righting can be achieved with thistechnique as all the five cases showed significantmolar up righting with a mean of 11.2 o angularchanges and a mean linear change of 3.6mm in

just two months. No root movement was noted.Almost all cases had some pain during thetreatment but for a lesser duration. The appliancewas well accepted by all as there was no breakageor dislodgement & no periodontal damage wasnoticed.

REFERENCES

1. Vanarsdall.R.L & Swartz.M.L : Molar Up righting : OrmcoCatalog No. 740-0014,Glendora,Calif-1980

2. Elie Capelluto & Isabelle Lauweryns: A simple technique formolar uprighting.JCO February 1997 Volume xxxi Numberz.

3. Angle.E.H: New System of Regulation and Retention. DentRegister 41: 497-603, 1887.

4. Graber.T.M: Orthodontics: Principles and Practice: E D. 3,Philadelphia 1972, W.B. Saunders Company.

5. Hom.B.M & Turley. P. K: The Effects of Space Closure of Mandibular First Molar Area in Adults. A J O D O 1984June(457-469)

6. Levitas. T. C: A Simple Technique for Correcting an EctopicallyErupting First Permanent Molar. J. Dent. Child. 31: 16-18,1964

7. Sim. J.M: Minor Tooth Movement in Children C.V. MosbyCo. St. Louis, 1972, PP.121-122

8. McDonald. R.E & Avery. D: Dentistry for the Child andadolescent ,2 nd Ed, C.V.Mosby Co , St Louis, 1974, PP. 382-387

9. Braden.R.E: Ectopic Eruption of Maxillary Permanent FirstMolars, Dent.Clin.N.Am.8 (2):441-448, 1964

10. Halterman.C.W: A Simple Technique for the Treatment of Ectopically Erupting Permanent First Molars, J.Am.Dent.Assoc. 105:1031-1033, 1982

STATISTICAL ANALYSIS[CEPHALOGRAMS]

1 Cephalogram Angular measurementMean 11.2 o

S.D 10.4 o

P < 0.05

2 Linear measurement of distal cusp tip of molarMean 3.6mmS.D 1.73mmP < 0.05

3 Linear measurement of distal root tip of molarMean 1mm

S.D 1.73mmP < 0.05

STATISTICAL ANALYSIS [STUDYMODELS]

1 Contact Point Distance Mean 2.2mm S.D 1.9mm P is less than 0.05

2 Cervical Distance Mean 1.2mm S.D 1.9mm P is less than 0.05

RESULT 95% change in crown angulations was noted

but the root movement was non significant.

DISCUSSIONA variety of appliances had been proposed to

upright tipped molars Levitas 6 and Sim 7

advocated twisting and inserting a brass wire intothe contact area of the impacted permanent firstmolar and the second primary molar so as to forcethe permanent molar to move distally. McDonaldand Avery 8 modified it by using self locking

separating springs. Braden9

recommended afixed lingual arch with finger spring to move themolar distally. Halterman 10 used elasticstretched between a long hook soldered to thelingual surface of primary second molar and abutton bonded to the first permanent molar. Mostof the techniques caused occlusal crownmovement that is along with up righting slightextrusion was also noted. M.U.S.T appliances areeasy to use and the superelastic nickel titaniumwire produces a distalizing force against the molartube and an opposing force to the centre of

Molar Uprighting Simple Technique

Documents

Transcript of Molar Uprighting Simple Technique